Dietary cholesterol may no longer be verboten for most Americans, if the US secretaries of Agriculture and Health and Human Services (HHS) accept a recommendation from the 2015 Dietary Guidelines Advisory Committee (DGAC).1

The recommendation came after panel members spent more than a year reviewing the latest evidence on how what we eat—and where we eat—affects our overall health. DGAC called for cholesterol to be removed from the list of “nutrients of concern for overconsumption” in a wide-ranging report issued February 19, 2015.1 Ironically, the report came out just as the British journal The Lancet released a 6-part call to action for governments worldwide to take proactive steps against rising rates of obesity (see SP148). The change in the cholesterol recommendation was first reported by The Washington Post.2

The cholesterol change is based on a 2013 review by the American Heart Association and the American College of Cardiology3; the dietary panel said current evidence “shows no appreciable relationship between consumption of dietary cholesterol and serum cholesterol.”1

The new recommendation has drawn mixed reviews; some say there is no reason for healthy adults to avoid naturally occurring cholesterol in foods like eggs or seafood. Others worry that Americans will take the change as a license to continue to add saturated fats to their diets, which, as the DGAC notes elsewhere, is a signicant problem. And the change may not apply to persons with diabetes, which could create challenges for patients and those who treat them.2

The beef industry is expected to resist some findings, such as: “Moderate evidence indicates that healthy dietary patterns higher in vegetables, fruits, and whole grains and lower in red and processed meats, high-fat dairy products, rened grains, and sweets/sugar-sweetened beverages reduce the risk of developing type 2 diabetes.”1 The beverage industry is expected to respond to findings about added sugar, which include: “Strong and consistent evidence shows that intake of added sugars from food and/or sugar-sweetened beverages are associated with excess body weight in children and adults.” The panel called for added sugar intake to be less than 10% of total calories.1

The day the report was released, the Physicians’ Committee for Responsible Medicine led a petition with the US Department of Agriculture for cholesterol to remain a “nutrient of concern” while praising the report for highlighting the benefits of plant-based diets. In a press release, the Physicians Committee said: “The major findings regarding sustainable diets were that a diet higher in plant-based foods, such as vegetables, fruits, whole grains, legumes, nuts, and seeds, and lower in calories and animal based foods is more health promoting and is associated with less environmental impact than is the current US diet.”4

The report concludes the work of the advisory committee, which is convened every 5 years by law to advise the 2 secretaries, who get the last word on the 2015 Dietary Guidelines for Americans. The guidelines are the nation’s official nutrition policy and affect everything from military meals to nutrition programs for poor mothers and children to school lunches. The 2010 guidelines informed the law that overhauled the National School Lunch Program, triggering a backlash from school cafeteria officials and students.5,6 The secretaries can change the recommendations, but historically, the DGAC’s outline is left intact. (The report is subject to a 45-day comment period and a public hearing.)7

A discussion of national nutrition policy and the 2015 guidelines featuring Frank Hu, MD, MPH, a DGAC member from the Harvard School of Public Health, took place April 17, 2015, at Patient-Centered Diabetes Care, in Boston. The meeting was hosted by The American Journal of Managed Care and Joslin Diabetes Center. (Look for the upcoming special issue of Evidence-Based Diabetes Management on the conference.)

While the cholesterol change will capture the public’s attention, the 2015 report contains plenty of sobering news for public health ofcials. Starting in the late childhood years, Americans fall far short of recommended levels of fruit and vegetable consumption, and this pattern continues into early adulthood. As adults age, there is some recovery of vegetable consumption, and those aged 51 to 70 years report the highest vegetable intake. However, most Americans continue to consume less-than-recommended levels of dark green or other colored vegetables.

The report notes that (white) potatoes are “the most commonly consumed single vegetable,” and account for 25 percent of all vegetable consumption. While the DGAC cites potatoes as “a good source of both potassium and fiber,” the report also breaks down the methods of preparation, some of which are less than healthy: 31% being boiled (including mashed and in dishes such as potato salad, soups, and stews), 22% as chips, sticks, or puffs, 19% as french fries, 17% as baked, and 12% as home fries or hash browns.

As promised, the DGAC’s scientic report bursts with information about changing patterns of American food consumption, and the implications for what Americans consume and overall health.1,9 In fact, parts of the report lend credence to some of the complaints about the difficulty implemeting the school lunch program. The report finds that “Action is needed across all sectors of food production, distribution, and consumption at individual behavioral and population levels….Individuals, families, schools, worksites, healthcare and public health settings, restaurants, and other food establishments must work together” to implement the following recommendations:

• Americans must increase their intake of underconsumed food groups—such as fruits and vegetables—and nutrient-dense foods, “while maintaining energy balance, and without increasing saturated fat, sodium, and added sugars.” In other words, Americans must eat more vegetables without layering on added butter, cheese or salt.

• Adding more low-fat/fat-free fluid milk and yogurt to diets while decreasing cheese would result in higher intakes of magnesium, potassium, vitamin A, and vitamin D while reducing the intake of sodium and saturated fat.

Beyond the cholesterol recommendation, the DGAC’s report listed several “nutrients of concern for underconsumption,” which were vitamin D, calcium, potassium, fiber, and, for pregnant women especially, iron. Nutrients of concern for overconsumption were sodium and saturated fat. The panel also said that Americans “underconsume” vitamin A, vitamin E, folate, vitamin C, and magnesium. The DGAC’s recommendations on dairy are also likely to draw criticism. As reported in Evidence-Based Diabetes Management, a parade of witnesses testified at the panel’s public hearing that there are ways to get calcium into diets without relying on dairy, and that dairy is harmful to some populations. The Harvard School of Public Health even released its own version of the “MyPlate” diagram with less focus on dairy.9

REFERENCES

1. Scientific report of the 2015 Dietary Guidelines Advisory Committee. US Office of Disease Prevention and Health Promotion website. http://www.health.gov/dietaryguidelines/2015-scientific-report/. Published and accessed February 18, 2015.

2. Whoriskey P. The U.S. government is poised to withdraw longstanding warnings about cholesterol. The Washington Post website. http://www.washingtonpost.com/blogs/wonkblog/wp/2015/02/10/feds-poised-to-withdraw-long-standing-warnings-about-dietary-cholesterol/. Published February 10, 2015. Accessed February 11, 2015.